Healthcare Provider Details

I. General information

NPI: 1437739869
Provider Name (Legal Business Name): JOHNNY JASON YANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 US HIGHWAY 61 STE N-1000
CRYSTAL CTY MO
63028-4136
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-9300
  • Fax: 636-933-9114
Mailing address:
  • Phone: 314-364-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026038969
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: